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Patient Forms

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Inova Primary Care
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Inova Primary Care
Patient fill out forms

Patient Forms

If you are a new patient seeing an Inova primary care or specialty doctor, you may be asked to complete the forms below and bring them with you to your appointment.

There may be additional forms your specific physician needs you to complete once you arrive at the office. Please arrive 15-20 minutes before your appointment to complete any other needed paperwork. Also remember to bring your insurance card and photo ID to each visit, as well as a list of your medications (prescription and over-the-counter).

    Forms for All Patients

    • Inova Physician Services patient registration form
    • Authorization for claims payment and reviews
    • Notice of privacy practices
    • Acknowledgment of receipt of notice of privacy practices
    • ADA special needs assessment
    • Patient Record of Disclosure: Preferred Contacts
    • Patient Rights and Responsibilities
    • Notice of Non-Discrimination

    Medical Release Forms

    • Release of medical information form
      (To ask Inova to release your medical records to another doctor's office)
    • Standard medical record release
      (To ask another doctor's office to release your records to Inova)

    Primary Care Patients – Medical History Form

    This form should be completed by all new patients who are seeing an Inova Medical Group primary care provider.

    • Inova Medical Group health history form

    Specialty Care

    Our specialty care offices will often have additional forms specific to their practice that they will ask you to complete. Please refer to the online content for your specialty physician's practice to see if other forms may also be requested.

    Inova wants you to be aware of your rights, and responsibilities, as a patient. We believe your patient rights are important, and we will do everything possible to make sure that your rights are respected.

    Download our Patient Rights and Responsibilities Information

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    Fairfax, VA 22031
    8095 Innovation Park Drive,
    Fairfax, VA 22031
    Questions? Call 855-694-6682

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